Skip to main content

Advertisement

Log in

Is Psoriatic Arthritis a Result of Abnormalities in Acquired or Innate Immunity?

  • PSORIATIC ARTHRITIS (O FITZGERALD AND P HELLIWELL, SECTION EDITORS)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Psoriatic arthritis is a common chronic inflammatory joint disease in which both inflammation and tissue damage contribute to the patient’s outcome. Abnormal activation of the innate and the adaptive immune system contributes to the chronic disease process. Novel insights into these immune pathways are further corroborated by genetic evidence. In this review, we compare the current paradigm of psoriasis to mechanisms that likely play a role in psoriatic arthritis and provide an overview of the role of immune mechanisms in the different features of the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Ibrahim G, Waxman R, Helliwell PS. The prevalence of psoriatic arthritis in people with psoriasis. Arthritis Rheum. 2009;61(10):1373–8.

    Article  PubMed  CAS  Google Scholar 

  2. Gladman DD. Natural history of psoriatic arthritis. Bailliere’s Clin Rheumatol. 1994;8(2):379–94.

    Article  CAS  Google Scholar 

  3. Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med. 2009;361(5):496–509.

    Article  PubMed  CAS  Google Scholar 

  4. • Di Meglio P, Perera GK, Nestle FO. The multitasking organ: recent insights into skin immune function. Immunity. 2011;35(6):857–69. This excellent review clearly illustrates the role of the skin as an immune barrier and basic mechanisms of chronic immune-mediated skin diseases.

    Article  PubMed  Google Scholar 

  5. Lande R, Gregorio J, Facchinetti V, et al. Plasmacytoid dendritic cells sense self-DNA coupled with antimicrobial peptide. Nature. 2007;449(7162):564–9.

    Article  PubMed  CAS  Google Scholar 

  6. Ganguly D, Chamilos G, Lande R, et al. Self-RNA-antimicrobial peptide complexes activate human dendritic cells through TLR7 and TLR8. J Exp Med. 2009;206(9):1983–94.

    Article  PubMed  CAS  Google Scholar 

  7. Wilson NJ, Boniface K, Chan JR, et al. Development, cytokine profile and function of human interleukin 17-producing helper T cells. Nat Immunol. 2007;8(9):950–7.

    Article  PubMed  CAS  Google Scholar 

  8. Ma HL, Liang S, Li J, et al. IL-22 is required for Th17 cell-mediated pathology in a mouse model of psoriasis-like skin inflammation. J Clin Invest. 2008;118(2):597–607.

    PubMed  CAS  Google Scholar 

  9. Moll JM, Wright V. Psoriatic arthritis. Semin Arthritis Rheum. 1973;3(1):55–78.

    Article  PubMed  CAS  Google Scholar 

  10. Nash P, Mease PJ, Braun J, van der Heijde D. Seronegative spondyloarthropathies: to lump or split? Annals Rheum Dis. 2005;64 Suppl 2:ii9–13.

    Article  Google Scholar 

  11. Dougados M. Psoriatic arthritis: is it for real? Joint Bone Spine. 2007;74(4):311–2.

    Article  PubMed  Google Scholar 

  12. Klareskog L, Catrina AI, Paget S. Rheumatoid arthritis. Lancet. 2009;373(9664):659–72.

    Article  PubMed  CAS  Google Scholar 

  13. Tan AL, McGonagle D. Psoriatic arthritis: correlation between imaging and pathology. Joint Bone Spine. 2010;77(3):206–11.

    Article  PubMed  Google Scholar 

  14. McGonagle D, Lories RJ, Tan AL, Benjamin M. The concept of a “synovio-entheseal complex” and its implications for understanding joint inflammation and damage in psoriatic arthritis and beyond. Arthritis Rheum. 2007;56(8):2482–91.

    Article  PubMed  Google Scholar 

  15. Lories R. The balance of tissue repair and remodeling in chronic arthritis. Nat Rev Rheumatol. 2011;7(12):700–7.

    Article  PubMed  CAS  Google Scholar 

  16. Pattison E, Harrison BJ, Griffiths CE, et al. Environmental risk factors for the development of psoriatic arthritis: results from a case–control study. Ann Rheum Dis. 2008;67(5):672–6.

    Article  PubMed  CAS  Google Scholar 

  17. Kamradt T, Schubert D. The role and clinical implications of G6PI in experimental models of rheumatoid arthritis. Arthritis Res Ther. 2005;7(1):20–8.

    Article  PubMed  CAS  Google Scholar 

  18. Armaka M, Apostolaki M, Jacques P, et al. Mesenchymal cell targeting by TNF as a common pathogenic principle in chronic inflammatory joint and intestinal diseases. J Exp Med. 2008;205(2):331–7.

    Article  PubMed  CAS  Google Scholar 

  19. McGonagle D. Enthesitis: an autoinflammatory lesion linking nail and joint involvement in psoriatic disease. J Eur Acad Dermatol Venereol. 2009;23 Suppl 1:9–13.

    Article  PubMed  CAS  Google Scholar 

  20. Tan AL, Benjamin M, Toumi H, et al. The relationship between the extensor tendon enthesis and the nail in distal interphalangeal joint disease in psoriatic arthritis—a high-resolution MRI and histological study. Rheumatology (Oxford). 2007;46(2):253–6.

    Article  CAS  Google Scholar 

  21. Lande R, Giacomini E, Serafini B, et al. Characterization and recruitment of plasmacytoid dendritic cells in synovial fluid and tissue of patients with chronic inflammatory arthritis. J Immunol. 2004;173(4):2815–24.

    PubMed  CAS  Google Scholar 

  22. Jongbloed SL, Lebre MC, Fraser AR, et al. Enumeration and phenotypical analysis of distinct dendritic cell subsets in psoriatic arthritis and rheumatoid arthritis. Arthritis Res Ther. 2006;8(1):R15.

    Article  PubMed  Google Scholar 

  23. •• Wenink MH, Santegoets KC, Butcher J, et al. Impaired dendritic cell proinflammatory cytokine production in psoriatic arthritis. Arthritis Rheum. 2011;63(11):3313–22. This article reports on a novel finding in PsA. Dendritic cells appear defective in producing cytokines after in vitro stimulation. This defective function may play an essential role in the pathogenesis of the disease.

    Article  PubMed  CAS  Google Scholar 

  24. Rambukkana A, Das PK, Witkamp L, et al. Antibodies to mycobacterial 65-kDa heat shock protein and other immunodominant antigens in patients with psoriasis. J Investig Dermatol. 1993;100(1):87–92.

    Article  PubMed  CAS  Google Scholar 

  25. Jandus C, Bioley G, Rivals JP, et al. Increased numbers of circulating polyfunctional Th17 memory cells in patients with seronegative spondylarthritides. Arthritis Rheum. 2008;58(8):2307–17.

    Article  PubMed  Google Scholar 

  26. Leipe J, Grunke M, Dechant C, et al. Role of Th17 cells in human autoimmune arthritis. Arthritis Rheum. 2010;62(10):2876–85.

    Article  PubMed  CAS  Google Scholar 

  27. Yeremenko N, Baeten D. IL-17 in spondyloarthritis: is the T-party over? Arthritis Res Ther. 2011;13(3):115.

    Article  PubMed  CAS  Google Scholar 

  28. • Noordenbos T, Yeremenko N, Gofita I, et al. Interleukin-17-positive mast cells contribute to synovial inflammation in spondylarthritis. Arthritis Rheum. 2012;64(1):99–109. All too often, IL-17 is uniquely associated with T cells. This article shows that this is not a correct assumption.

    Article  PubMed  CAS  Google Scholar 

  29. Glatigny S, Fert I, Blaton MA, et al. Proinflammatory Th17 cells are expanded and induced by dendritic cells in spondylarthritis-prone HLA-B27-transgenic rats. Arthritis Rheum. 2012;64(1):110–20.

    Article  PubMed  CAS  Google Scholar 

  30. Canete JD, Martinez SE, Farres J, et al. Differential Th1/Th2 cytokine patterns in chronic arthritis: interferon gamma is highly expressed in synovium of rheumatoid arthritis compared with seronegative spondyloarthropathies. Ann Rheum Dis. 2000;59(4):263–8.

    Article  PubMed  CAS  Google Scholar 

  31. Mease P, Genovese MC, Gladstein G, et al. Abatacept in the treatment of patients with psoriatic arthritis: results of a six-month, multicenter, randomized, double-blind, placebo-controlled, phase II trial. Arthritis Rheum. 2011;63(4):939–48.

    Article  PubMed  CAS  Google Scholar 

  32. Gottlieb A, Menter A, Mendelsohn A, et al. Ustekinumab, a human interleukin 12/23 monoclonal antibody, for psoriatic arthritis: randomised, double-blind, placebo-controlled, crossover trial. Lancet. 2009;373(9664):633–40.

    Article  PubMed  CAS  Google Scholar 

  33. Strober BE, Crowley JJ, Yamauchi PS, et al. Efficacy and safety results from a phase III, randomized controlled trial comparing the safety and efficacy of briakinumab with etanercept and placebo in patients with moderate to severe chronic plaque psoriasis. Br J Dermatol. 2011;165(3):661–8.

    Article  PubMed  CAS  Google Scholar 

  34. Ritchlin CT, Kavanaugh A, Gladman DD, et al. Treatment recommendations for psoriatic arthritis. Ann Rheum Dis. 2009;68(9):1387–94.

    Article  PubMed  CAS  Google Scholar 

  35. Vandooren B, Noordenbos T, Ambarus C, et al. Absence of a classically activated macrophage cytokine signature in peripheral spondylarthritis, including psoriatic arthritis. Arthritis Rheum. 2009;60(4):966–75.

    Article  PubMed  CAS  Google Scholar 

  36. Kruithof E, Baeten D, De Rycke L, et al. Synovial histopathology of psoriatic arthritis, both oligo- and polyarticular, resembles spondyloarthropathy more than it does rheumatoid arthritis. Arthritis Res Ther. 2005;7(3):R569–80.

    Article  PubMed  CAS  Google Scholar 

  37. Lories RJ, Baeten DL. Differences in pathophysiology between rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol. 2009;27(4 Suppl 55):S10–4.

    PubMed  CAS  Google Scholar 

  38. Lories RJ. Joint homeostasis, restoration, and remodeling in osteoarthritis. Best Pract Res Clin Rheumat. 2008;22(2):209–20.

    Article  CAS  Google Scholar 

  39. Siannis F, Farewell VT, Cook RJ, et al. Clinical and radiological damage in psoriatic arthritis. Ann Rheum Dis. 2006;65(4):478–81.

    Article  PubMed  CAS  Google Scholar 

  40. van der Heijde D, Kavanaugh A, Gladman DD, et al. Infliximab inhibits progression of radiographic damage in patients with active psoriatic arthritis through one year of treatment: results from the induction and maintenance psoriatic arthritis clinical trial 2. Arthritis Rheum. 2007;56(8):2698–707.

    Article  PubMed  Google Scholar 

  41. van Kuijk AW, DeGroot J, Koeman RC, et al. Soluble biomarkers of cartilage and bone metabolism in early proof of concept trials in psoriatic arthritis: effects of adalimumab versus placebo. PloS one. 2010, 5(9).

  42. Schett G, David JP. The multiple faces of autoimmune-mediated bone loss. Nat Rev Endocrinol. 2010;6(12):698–706.

    Article  PubMed  CAS  Google Scholar 

  43. Xiong J, Onal M, Jilka RL, et al. Matrix-embedded cells control osteoclast formation. Nat Med. 2011;17(10):1235–41.

    Article  PubMed  CAS  Google Scholar 

  44. Nakashima T, Hayashi M, Fukunaga T, et al. Evidence for osteocyte regulation of bone homeostasis through RANKL expression. Nat Med. 2011;17(10):1231–4.

    Article  PubMed  CAS  Google Scholar 

  45. Okamoto K, Takayanagi H. Osteoclasts in arthritis and Th17 cell development. Int Immunopharmacol. 2011;11(5):543–8.

    Article  PubMed  CAS  Google Scholar 

  46. Pollinger B, Junt T, Metzler B, et al. Th17 cells, not IL-17+ gammadelta T cells, drive arthritic bone destruction in mice and humans. J Immunol. 2011;186(4):2602–12.

    Article  PubMed  Google Scholar 

  47. Ritchlin CT, Haas-Smith SA, Li P, et al. Mechanisms of TNF-alpha- and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis. J Clin Invest. 2003;111(6):821–31.

    PubMed  CAS  Google Scholar 

  48. Colucci S, Brunetti G, Cantatore FP, et al. Lymphocytes and synovial fluid fibroblasts support osteoclastogenesis through RANKL, TNFalpha, and IL-7 in an in vitro model derived from human psoriatic arthritis. J Pathol. 2007;212(1):47–55.

    Article  PubMed  CAS  Google Scholar 

  49. Chiu YG, Shao T, Feng C, et al. CD16 (FcRgammaIII) as a potential marker of osteoclast precursors in psoriatic arthritis. Arthritis Res Ther. 2010;12(1):R14.

    Article  PubMed  Google Scholar 

  50. Vandooren B, Cantaert T, Noordenbos T, et al. The abundant synovial expression of the RANK/RANKL/Osteoprotegerin system in peripheral spondylarthritis is partially disconnected from inflammation. Arthritis Rheum. 2008;58(3):718–29.

    Article  PubMed  CAS  Google Scholar 

  51. Lories RJ, Luyten FP, de Vlam K. Progress in spondylarthritis. Mechanisms of new bone formation in spondyloarthritis. Arthritis Res Ther. 2009;11(2):221.

    Article  PubMed  Google Scholar 

  52. Maksymowych WP. Disease modification in ankylosing spondylitis. Nat Rev Rheumatol. 2010;6(2):75–81.

    Article  PubMed  Google Scholar 

  53. Lories RJ, Derese I, Ceuppens JL, Luyten FP. Bone morphogenetic proteins 2 and 6, expressed in arthritic synovium, are regulated by proinflammatory cytokines and differentially modulate fibroblast-like synoviocyte apoptosis. Arthritis Rheum. 2003;48(10):2807–18.

    Article  PubMed  CAS  Google Scholar 

  54. Diarra D, Stolina M, Polzer K, et al. Dickkopf-1 is a master regulator of joint remodeling. Nat Med. 2007;13(2):156–63.

    Article  PubMed  CAS  Google Scholar 

  55. Lories RJ, Derese I, de Bari C, Luyten FP. Evidence for uncoupling of inflammation and joint remodeling in a mouse model of spondylarthritis. Arthritis Rheum. 2007;56(2):489–97.

    Article  PubMed  Google Scholar 

  56. Eder L, Chandran V, Gladman DD. Repair of radiographic joint damage following treatment with etanercept in psoriatic arthritis is demonstrable by 3 radiographic methods. J Rheumatol. 2011;38(6):1066–70.

    Article  PubMed  Google Scholar 

  57. •• O’Rielly DD, Rahman P. Genetics of susceptibility and treatment response in psoriatic arthritis. Nat Rev Rheumatol. 2011;7(12):718–32. This is an excellent summary of recent progress in the genetics of PsA, adequately discussed in comparison with psoriasis. Moreover, an interesting section on pharmacogenomics is included.

    Article  PubMed  Google Scholar 

  58. Sonder SU, Saret S, Tang W, et al. IL-17-induced NF-kappaB activation via CIKS/Act1: physiologic significance and signaling mechanisms. J Biol Chem. 2011;286(15):12881–90.

    Article  PubMed  CAS  Google Scholar 

  59. Bowes J, Eyre S, Flynn E, et al. Evidence to support IL-13 as a risk locus for psoriatic arthritis but not psoriasis vulgaris. Ann Rheum Dis. 2011;70(6):1016–9.

    Article  PubMed  Google Scholar 

  60. Eder L, Chandran V, Pellett F, et al. IL13 gene polymorphism is a marker for psoriatic arthritis among psoriasis patients. Ann Rheum Dis. 2011;70(9):1594–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

Dr. Lories has served as a consultant for Pfizer, Abbott Laboratories, Merck & Co., and Celgene Corp.; has received grant support from Pfizer and Abbott Laboratories; has received payment for development of educational presentations (including service on speakers’ bureaus) from Merck & Co. and UCB; and has had travel/accommodations expenses covered/reimbursed by Abbott Laboratories and Merck & Co.

Dr. de Vlam reported no potential conflicts of interest relevant to this article.

Dr. Lories and Dr. de Vlam are holders of the KU Leuven Abbott Chair for Psoriatic Arthritis Research.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rik J. Lories.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lories, R.J., de Vlam, K. Is Psoriatic Arthritis a Result of Abnormalities in Acquired or Innate Immunity?. Curr Rheumatol Rep 14, 375–382 (2012). https://doi.org/10.1007/s11926-012-0257-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-012-0257-3

Keywords

Navigation